Twin‐to‐twin transfusion syndrome: Perinatal outcome and recipient heart disease according to treatment strategy. Issue 1 (21st December 2012)

• Record Type: Journal Article
• Authors: Barrea, Catherine; Debauche, Christian; Williams, Olivia; Jasienski, Stéphanie; Steenhaut, Patricia; Sluysmans, Thierry; Bernard, Pierre; Hubinont, Corinne
• Is Part Of: Journal of paediatrics and child health. Volume 49:Issue 1(2013:Jan.)
• Page Start: E28
• Page End: E34
• Publication Date: 2012-12-21
• Subjects: Children -- Health and hygiene -- Periodicals; Pediatrics -- Periodicals; 618.92
• DOI: 10.1111/jpc.12060
• Languages: English
• ISSNs: 1034-4810

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jpc12060-sec-0001" sec-type="section"> <title>Aim</title> <p>The aims of the study were to compare perinatal outcome and assess recipient cardiac disease according to treatment strategy (amnioreduction (AR), laser or selective feticide).</p> </sec> <sec id="jpc12060-sec-0002" sec-type="section"> <title>Methods</title> <p>We retrospectively reviewed 81 consecutive cases of twin‐to‐twin transfusion syndrome diagnosed before 28 weeks between 1993 and 2007.</p> </sec> <sec id="jpc12060-sec-0003" sec-type="section"> <title>Results</title> <p>Although fetuses treated by laser were younger at diagnosis (median 20.4 vs. 22.4 weeks, <italic>P</italic> = 0.01), they were significantly older at birth (median 33.6 vs. 28.5 weeks, <italic>P</italic> = 0.004) than those treated by AR. Neonatal morbidity was globally lower after laser than AR, and cardiac insufficiency tended to be less frequent (31% vs. 57%, <italic>P</italic> = 0.09). There was a trend towards increased perinatal survival after laser treatment (68% vs. 49%, <italic>P</italic> = 0.1). Heart failure was the cause of death in half (23/46) of the recipients. Fetal heart failure leading to death was 2.7 times more frequent after AR than after laser (<italic>n</italic> = 11 vs. <italic>n</italic> = 4), and all four neonatal cardiac deaths occurred after AR. Compared with laser, selective feticide did not further improve the outcome.</p> </sec> <sec id="jpc12060-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Heart failure was an important cause of perinatal morbidity and death. However, laser therapy resulted in a longer diagnosis–delivery interval and lower global neonatal morbidity than AR, with a trend towards increased perinatal survival. Improved outcome after laser treatment compared with AR might be related to its impact on recipient heart disease.</p> </sec> </abstract>